Abstract
Underuse of thromboprophylaxis in hospitalized medical patients is still common worldwide. Little is known about the use of thromboprophylaxis in patients with pulmonary diseases in everyday hospital practice. The aim of this study was to assess the use of pharmacological prophylaxis of venous thromboembolism (VTE) in real-life patients with pulmonary diseases. In this retrospective study, 2 validated scoring systems, i.e., the Padua prediction score and Caprini VTE risk assessment, were used to assess the VTE risk in 2011 patients (1133 men and 878 women), aged 18 years or more, hospitalized for pulmonary diseases (median 6 days) in a single tertiary pulmonary medical center from January to December 2014. Using the Padua prediction score, we identified 428 (21.28%) patients at a high risk for VTE, including 167 (39.01%) who received thromboprophylaxis with low-molecular-weight heparin, and 261 (60.98%) individuals at a high risk without thromboprophylaxis (p < 0.001). A total of 888 (44.16%) patients who scored 5 points or more using the Caprini VTE risk assessment were identified as subjects at a high risk for VTE, including 34.79% of patients receiving thromboprophylaxis. From among patients at a high risk for VTE, 579 (65.20%) did not receive appropriate thromboprophylaxis (p < 0.001). Underuse of thromboprophylaxis was observed more commonly among patients hospitalized for lung cancer or pneumonia (50.60% and 24.87% of patients at a high risk for VTE without prophylaxis, respectively). Thromboprophylaxis is underutilized in hospitalized patients with pulmonary diseases regardless of the scoring system used. Implementation of thromboprophylaxis should be markedly improved in this patient group.
Highlights
Hospitalization is associated with an increased risk of developing venous thromboembolism (VTE) and leads to 10–20% of the VTE episodes in the general population.[1,2,3] Importantly, 10% of in-hospital deaths are related to VTE.[4,5,6] It has been estimated that 42% of hospitalized patients are at an intermediate or high risk for VTE.[1]
Using the Padua prediction score, we identified 428 (21.28%) patients at a high risk for VTE, including 167 (39.01%) who received thromboprophylaxis with low-molecular-weight heparin, and 261 (60.98%) individuals at a high risk without thromboprophylaxis (p < 0.001)
A total of 888 (44.16%) patients who scored 5 points or more using the Caprini VTE risk assessment were identified as subjects at a high risk for VTE, including 34.79% of patients receiving thromboprophylaxis
Summary
Hospitalization is associated with an increased risk of developing venous thromboembolism (VTE) and leads to 10–20% of the VTE episodes in the general population.[1,2,3] Importantly, 10% of in-hospital deaths are related to VTE.[4,5,6] It has been estimated that 42% of hospitalized patients are at an intermediate or high risk for VTE.[1]. The 2012 and 2016 guidelines of the American College of Chest Physicians (ACCP) strongly recommend pharmacologic prophylaxis among hospitalized patients at a high risk for VTE (grade 1B), or mechanical thromboprophylaxis in patients at a high risk for VTE as well as for bleeding, or those who bleed actively (grade 2C).[9,10] Identification of high-risk VTE patients who should receive thromboprophylaxis during the hospital stay can be done by means of validated scoring systems, which usually divide patients into high and low risk groups Little is known about the use of thromboprophylaxis in patients with pulmonary diseases in everyday hospital practice
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